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also it is absolutely necessary to take into account. Theseare the advanced-stage patients who remain in their dwellingsand those who are already too far gone for the sanatoriumtreatment but not yet so far that they are unfit for work andmust go to a hospital. Should these tuberculous patients,whose number, as already said, is very considerable, be leftto their fate, a great gap would be made thereby in the lineof battle. The merit of having filled this gap belongsto Calmette, to whom occurred the happy idea of

providing for this class of patients by the dispensariesorganised by him. Calmette’s suggestion has met with

approval everywhere, especially in Germany, where morethan 50 such dispensaries already exist and where

many cities are about to provide themselves with such. Itwas in Germany, too, that the dispensaries, which wereoriginally intended only to give working people gratuitousadvice, medicinal treatment, and at the same time materialsupport, were widened and completed in an importantmanner under the guidance of Putter and Kayserling. In theirpresent form they are intended to serve not one particularclass only but all helpless tuberculous patients in every way.The patient is visited in his dwelling and instruction andadvice as to cleanliness and the treatment of the sputumare given to him and his family. If the domiciliary con-ditions are bad, money is granted in order to render the

separation of the patient from the healthy members of hisfamily possible and thus to convert a dangerous patientinto a comparatively harmless one by hiring a suitableroom or even another dwelling. In other respects also

poor families are supported by gifts of suitable provisions,fuel, &c. The dispensary itself does not undertake thetreatment of the patients, in order not to get into conflictwith practitioners, but it takes care that they are

placed under medical treatment and, if advisable, admittedto a hospital, a sanatorium, or a health-recruiting home.One specially important part of their work is that theysupervise the family, and especially the children, and havethem examined from time to time to see whether infectionhas taken place in order to be able to bring help as early aspossible. In this way these dispensaries really take care ofpoor consumptives and they have therefore with perfectjustice been named ., care-stations." " I regard them as oneof the most powerful means of combating tuberculosis, ifnot the most powerful of all, and I believe that when, as wemay hope, a dense net of care-stations overspreads the landthey are destined to do a most blessed work.The measures hitherto discussed-namely, notification,

hospitals, sanatoriums, and care-stations, are the heavyartillery in the battle against tuberculosis. But there are

lighter weapons, too, which cannot themselves exercise soincisive an effect, but the cooperative help of which wecannot dispense with. Among these I reckon in the first

place all efforts to instruct the people as to the danger oftuberculosis and to keep the interest of the masses in the

combating of tuberculosis awake by popular publications,lectures, exhibitions, and other such means. Later, whenthere are care-stations enough, the said instruction willemanate from them so copiously that we shall hardlyneed special arrangements for that any more, but forthe present we cannot dispense with them. Veryvaluable help is also given by the numerous associa-tions which take part in the combating of tuber-culosis by collecting money in order to found sanatoriumsand health recruiting homes, endow free beds, supportthe families of poor phthisical patients, &c. We mustnot shut our eyes to the fact that the combating of tuber-culosis demands a great deal of money. It is at bottomonly a money question. The more free beds are endowedfor cases of pulmonary phthisis in well organised andconducted establishments for the cure and care of the sick,the more adequately the families of tuberculous patients aresupported, so that the latter may not be deterred fromgoing to such establishments by anxiety on behalf ofthose belonging to them, and the more care-stations are

established, the more rapidly will tuberculosis as an

epidemic disease decrease. As, however, it is hardlyto be expected that the municipalities, many of whichalready make very large sacrifices for the tuberculouspatients, will be able in the immediate future to do justiceto all requirements in this respect, private help is greatlyto be desired. Care must be taken, however, that the meanscollected by the associations or placed at disposal by in-dividual benefactors be not applied to minor matters, butaccrue to the benefit of the most effective measures, above

all the establishments for the accommodation of the sick andthe care-stations.

In the conflict against tuberculosis hardly anythingremains for the State to do, and yet it, too, can take aneffective part in it. It can by legislation introduce obligatorynotification, which already exists for all other importantepidemic diseases, for tuberculosis too. In several Statesthis has already been done, and it is to be hopedthat the other civilised States will soon follow this

example. Many demand also a legal basis for the

compulsory isolation of patients who are a specialsource of danger to those around them. My experience inthe combating of pestilences, however, teaches that we candispense with this hard measure. If only we as far as

possible facilitate the admission of consumptives to suitableestablishments for the sick in the manner already indicated,we shall attain all we need. In one respect, however, theState can render aid of extraordinary utility with a view,namely, to bettering the unfavourable donaieiliary conditions.Against this evil private activity is almost powerless, whereasthe State can easily provide a remedy by suitable laws.If we look back on what has been done in the last few

years in the combating of tuberculosis as an epidemicdisease we cannot but get the impression that a trulyimportant beginning has been made. The fight againsttuberculosis was not dictated from above and has not alwaysdeveloped in accordance with the rules of science. No ; itemanated from the people itself who have rightly recognisedits deadly enemy at last. It is pressing forward withelementary force, sometimes in a rather wild and disorderlymanner but gradually striking more and more into the rightpaths. The fight is kindled all along the line and the

enthusiasm for the lofty purpose is so general that flagging isnot to be feared. If it goes on in this vigorous style victoryis sure.

___

Three LecturesON

THE PRESERVATION OF HEALTH AMONGSTTHE PERSONNEL OF THE JAPANESE

NAVY AND ARMY.Delivered at St. Thomas’s Hospital, London, on May 7th,

9th, and 11th, 1906,

BY BARON TAKAKI, F.R.C.S. ENG., D.C.L.,LATE DIRECTOR-GENERAL OF THE MEDICAl DEPARTMENT OF THE

IMPERIAL JAPANESE NAVY.

LECTURE II.1Delivered 0!!. May 9th.

MR. PRESIDENT AND GENTLEMEN,-On Nov. 29th, 1883, Ihad the honour of being presented to his Imperial Majestyat Akasaka Palace, and on this occasion explained my viewsas regards the cause of, and preventive measures for, beri-beri.

THE METHODS FOR INVESTIGATING THE CAUSE OF BERI-BERI.

1. As we could not discover the true origin of beri-beri inspite of examination of symptoms, pathology, &c., we must

use some other means. 2. In order to examine the food

necessary for nourishing the human body it is important toknow the comparative scale of nutritive elements-that is,proteids, fat, carbohydrates and salts, and of carbon and

nitrogen. 3. On examining the food taken by those sufferingfrom beri-beri it is found that the proportion of these

elements is not correct. 4. The causes of this disease aredue to the loss of equilibrium in the proportion of nutritiveelements and also to the deficiency of a certain element-thatis, the composition of food is not correct. 5. The occur-rence of beri-beri due to the deficiency of a certainelement-that is, proteids-is shown in the examples ofthe long voyages of the Asama, Z’seakecba, RYlljo, &e. Thedisease does not occur if the food is well supplied ; for

example, it does not occur among men having a sufficient1 Lecture I. was published in THE LANCET of May 19th, 1906, p. 1369

X 2

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supply of food or among officers, and in voyages with longstoppages at ports and short sailings. From 1882 to 1883when the R!fhjO went for long voyages, the disease dis-

appeared completely as soon as she arrived at Hawaii andwas supplied with fresh articles of food. 6. High tem-perature, moisture, marshy air, over-crowding, hard labours,nervous exhaustion, coarse food, &c., cannot be consideredthe chief causes of beri-beri, because if they are the causesboth Europeans and Americans ought to suffer, but on thecontrary they do not. 7. On considering the question bothfrom theoretical and practical points i6 seems quite reason-able therefore to suppose that the true cause of beri-beri liesin a wrong method of diet. In December, 1883, instead ofthe very simple rules of the previous year, I compiled a newbook of instructions consisting of 77 articles and 22 blankforms, and had it used throughout the navy, with the

approval of the Minister of the Navy. This book, sinceseveral times revised, is still in use. On Jan. 15th, 1884,Jungi Kawamura, the Minister of the Navy, issued the

following notification to the navy :-" It is hereby orderedthat the following regulations in regard to the supply of foodto the petty officers and men in ships and barracks shall beobserved from Feb. lst, 1884."

REGULATIONS IN REGARD TO THE SUPPLY OF FOOD TO THE PETTYOFFICERS AND MEN IN SHIPS AND BARRACKS.

Article 1.-the food of petty officers and men in ships and barracksshall be under the control of the principal officer under whom they areserving and the articles of food shall be bought with the money allottedjfor the purpose and supplied to them.

Article JT.—The articles of food shall be as follows: Rice, bread, beefafresh or preserved), salted beef, salted pork, fowls or eggs, fish, miso.2IShoyu (sauce), vegetables (potatoes, carrots, radishes, cabbages, and- unions), beans, wheat, flour, tea, fats and oils (suet or lard, butter,,,,live oil, oil of the sesamum orientale), sugar (and starch), milk, vinegar,bpices, alcoholic liquors, salt, pickles.

Article III.-The articles of food shall be bought by the paymaster byrder of the officer in command and they shall be given out after beingexamined by the surgeon.

Article IV.-A record of the articles of food shall be kept by the pay-unaster. which record shall frequently be examined by the officer incommand.

Article V.-If the preserved articles of food are found to be in badcondition the matter shall be reported by the paymaster to the officerin command, who in turn shall order the surgeon or other officer toexamine them and shall report the matter to the Minister of the NavyDepartment through the chief of different departments.

TABLE XL-Daily Allowance of Food for One Bealthy Person(fixed on Feb. 2nd, 1884).

Momme. Ounces.

Eice ...... 180 =22’5 Bread, 160 momme (20 oz.) ; biscuit, 130ttice ...." - 1 momme (16-25 oz.)

When eggs are substituted, each egg to beMeat, fresh 80 =10’0 reckoned as equivalent to 10 momme

( (1-25 oz.)

Fish, fresh 40 - 5’0 I’i’here there is no fish, 20 nomme (2-5 oz.)tish, res - 1 of meat may be substituted.

lliso ...... 14 = 1’75 -

Shoyu...... 16 = 2’0 -

Vegetables.. 120 =15’0 -

Beans...... 12 = 1’5 -

Wheat flour 20 = 2’5 -

Tea ...... 2 = 0’25 -

Fat or oil ... 4 0-5 -

Sugar...... 20 = 2-5 -

M’lk 12 = 1’5 t If condensed milk, 12 momme (0’2oz.) to be1 ... ". 1! - i 1 given.

Vinegar ... 2 = 0’25 -

Spices ... 03= 0’05 -

Salt ...... 2 = 0’25 -

Pickles ... 20 = 2-25 -

Fruit...... - To be given with care.

Total ... 568’3=71

If the amount of 51 momme (6’37 oz.) of liquid food is subtractedthere remain 517’3 (64’65oz,) when rice is used, 497’3 (62 30oz,) when’bread is used, and 467’3 (58’40 oz.) when biscuit is used.

It is not necessary to give the exact allowance every daybut if the food of two weeks is averaged the average dailyallowance should be equivalent to the daily prescribedamount.

In 1883, after my proposal to reform the diet systemon Nov. 26th, I made a great effort in order that the’ls1hkuba should go over the same route as the Ryvjo.There was opposition to this from various points and

2 A kind of sauce made of beans, barley, and salt.

the permission could not be obtained easily but in theend after much discussion all difficulties were overcome,except that of expense. So with the knowledge of theMinister of the Navy I consulted Hakubun Ito, Coun-cillor of the Imperial Household, and Seigi Matsugata,the Minister of Finance, and finally obtained my objectby the special allowance of 60,000 yen (about 6000) fromthe Treasury. Before the sailing of the Tsuk1tba a specialcommittee for investigation was put on board and consistedof the following gentlemen : Captain S. Arichi, LieutenantY. Matsumara, Surgeon T. Aoki, and Paymaster N. Kataoka.The food-supply was ordered according to the new system.The vessel sailed on Feb. 2nd, 1884, and returned to

Shinagawa on Nov. 16th. The result obtained was good andis shown in the next table, comparing it with that of theRY1,jO.When the good report ("no beri-beri") of the experi-

mental voyage of the Tlntk1tba became known the principalmen in the navy for the first time began to support me in myfixed purpose. They said that they had always opposed mein their hearts and only obeyed the new regulations becausethey were ordered by the Minister, but they would give innow after such powerful practical proofs. In January, 1885,on looking through the reports of 1884 I was greatly satisfiedwith the results as shown in Table I. The number of generaldiseases was nearly halved and that of beri-beri was con-siderably decreased without a death.On Feb. 13th, 1885, I made a new proposal for using

barley and rice in equal proportion instead of rice alone andof having this adopted from March lst, as the season ofberi-beri was approaching, under the following rules-thatis, from March lst to 15tb, only once at breakfast ; fromMarch 16th to 31st, twice a day, morning and evening ;after April lst, at every meal. I did this for the followingreason. Although the number of cases of beri-beri in the navydecreased considerably (almost half the number in the yearbefore) and the deaths had become almost unprecedentedlyfew since the formation of our navy owing to the new foodregulations of February, 1884, yet the disease had not yetdisappeared completely and we were obliged to make furtherefforts to exterminate it. Then I thought of the planof using barley instead of bread alone, as the men

could eat the former better than the bread. From thisI expected better results. The Minister of the Navy orderedthe addition of the word barley" " amongst the articles offood and its practical application on Dec. 21st throughoutthe whole navy. As I saw uneasiness arising among thenaval officers and men owing to this change and as I wantedto report the full results of the investigation on the voyageof the HY11jO and to tell the purpose of this new

change I, with the approval of the Minister of the

Navy, delivered the following address at the Naval Clubon Feb. 25th :-All of the gentlemen here present will remember the Orders G,

No. 2743 (2), issued on the 29th November, 1883, and C, No. 7, issuedin January, 1884, by which regulations regarding food were made forthe first time. By last year’s experience we have found that most ofthe men dislike meat as well as bread, and we do not know what weshall do next. But if we leave the matter to their own choice we shallcertainly have a great many cases of beri-beri as has hitherto been thecase, especially as more than 1000 new men have been enlisted thisyear. Now, there is nothing better than barley food for preventingberi-beri. As, however, barley is coarse in appearance we are afraid thatsome of the men who do not understand the object ot the improvementin the scale of diet will feel dissatisfied. We consequently wish to speakabout the preventive measures to be adopted against beri-beri and to takethis opportunity of reporting the result of the examination into beri-beri on board the RY/ljo. That beri-beri can be prevented ty animprovement in the scale of diet has been deduced from scientificreasoning and has been proved by experience in our navy, and for a longtime we were planning such preventive measures. Fortunately,G. No. 2743 (2) was issued on the 29th November, 1883, directing thatnutritious food should be given as far as possible, to which followed theregulations in regard to the supply of fond, which were issued withC. No. 7 in January, 1884. According to those regulations the medicalbureau drew up tables showing the proper amount of food for healthymen and invalids and distributed these to vessels, barracks, andhospitals, thus trying to insure the health of the men. As we hadexpected, however, these suggestions often could not be carried out,especially in the case of newly enlisted men, who not only dislikebread but cannot take a proper amount of meat. If things are left insuch a condition there is no doubt, from recent experience, that weshall again have a great many cases of beri-beri this year in spite of thefavourable result shown in the decrease of cases of beri-beri which wasobtained in the year which followed the improvement in the scale ofdiet. This is why we decided to give the barley food. We believe that themajority of the men in our navy have been used to take barley food fromtheir childhood, so that in reality they can eat it, although theyshow their dissatisfaction at it after becoming accustomed to the ricegiven to them since they entered the navy. It is accordingly con-sidered that the best preventive measure at present against beri-beriwill be to give barley, which it was directed should be given to thenavy in general from the month of March by the order of the 21st inst.

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If this order is carried out strictly we are sure to find no cases of beri-beri in our navy. We consequently ask you, gentlemen, that you willkindly help us in the work ot prevention, for the good of our country,according to the order just given.

On March 19th, 1885, I obtained the honour of an inter-view with His Majesty the Emperor and presented the

reports of the following items : 1. The results of beri-beri

investigation on board the R:lJ1IjO. 2. The decrease of beri-beri from the gradual improvement of diet since Jan. 15th,1884. 3. A great probability of exterminating the diseasefrom the navy in a few years.On March 28th, 1885, I for the second time spoke on the

preventive measures of beri-beri before the meeting of theHygienic Society of Japan, the chief items of which were : -.1. The report of the investigation committee placed on boardthe training-ship RY1/jO during its voyage in 1883. 2. The

report of the experimental voyage of the 7MM& in 1884.3. The results obtained through the examination of foodsupplied in 1883-that is, the very small quantity of nitro-genous food as against the large amount of carbohydrates,the proportion being 1 of nitrogen to 28 of carbon. In

addition, the occurrence of numerous beri-beri and generaldiseases during that year. 4. The good results obtained byimproved diet since 1884 and the difference brought about inthe proportion of nitrogen and carbon by various changes inthe proportion of diet.On August 24th, 1885, I made a proposal to change bread

and biscuit for equally proportioned barley and rice whichhad been supplied since March of that year, because I

recognised its necessity owing to the great difficulties incooking during rough weather, even in time of peace. InNovember of that year my proposal was taken up and its

application was at once ordered. Finally, besides arrangingand investigating as described I had thought of experimentson dogs and in September, 1884, commenced my experi-ments. The results obtained were as follows :- ’

[Baron Takaki here gave a very detailed account ofexperiments made on the feeding of 12 dogs on various sub-stances, his object being to show the unsuitability of rice asa staple article of diet and the superiority of barley to- rice.The account included such minutise as the composition ofthe forenoon and afternoon rations, the date of birth of someof the dogs, and a full report of the post-mortem appearancespresented by those which died. The principal points ofinterest were as follows. In the first experiment, which wascommenced in the beginning of September, 1884, six dogswere used. The first of these dogs weighed 14 pounds (1800momme) and had a daily allowance of 5 ounces of rice,1’4 ounces of vegetable, ounce of miso, and i ounce

of soy. In a short time it gained 12 ounces in weight, butit afterwards gradually lost weight and became thin andweak ; its hair fell out very much, but the animal did notshow any symptom of disease. It died suddenly at the endof 307 days and was then found to have lost 3 pounds of itsoriginal weight ; the necropsy showed the presence of generalanasmia. The second dog weighed 152 pounds (2000 momme)and had a daily allowance of 10 ounces of rice, 2-2L ounces ofvegetable, 4 ounce of miso, and$ounce of soy. It increasedin weight for a short time but soon afterwards began towaste gradually and after about eight months there wasparalysis of the legs with complete inability to stand. Itdied at the end of 269 days ; the necropsy showed the

presence of general anaemia. The third dog weighed28 pounds (3600 momme) and had a daily allowance of10 ounces of rice, 2-2L ounces of vegetable, i ounce ofmiso, and$ounce of soy. Its weight at first increasedbut afterwards gradually decreased, and after about 11months there was paralysis of the legs with inabilityto walk. It died at the end of 337 days; thenecropsy showed that the brain, spinal cord, kidneys, andright lung were full of blood, whereas there was a deficiencyof blood in the rest of the body. The fourth dog weighed12t pounds (1600 momme) and had a daily allowance of25 ounces of rice, 14 ounces of vegetables, 1$ounces of freshbeef, ounce of dry bonito, a small piece of tofu (legumen),and -f. ounce of soy. It lost weight at first but afterwardsgradually regained it. As compared with the originalweight there was a gain of 22-2L ounces and after the lapseof 307 days the animal was still healthy and strong. Thefifth dog weighed 17 pounds (2200 momme) and had a dailyallowance of 5 ounces of rice, 3 ounces of fresh beef,22 ounces of vegetable, ounce of miso, ounce of soy, anda small piece of tofu (legumen). It at first increased inweight and then gradually decreased, but as compared with

the original weight there was a gain and after the lapse of261 days the animal was healthy and strong. The sixth dogweighed 56-4L pounds (7200 momme) and had a daily allow-ance of 72 ounces of rice, 5$ounces of fresh beef, 2 ouncesof vegetable, y ounce of soy, and a small piece of tofu

(legumen). In the course of the experiment the dog’sweight decreased in comparison with what it was at first,but after the lapse of 337 days the animal was still healthyand strong.The weight of the first three dogs (which may be called

the first A group) as compared with the original weightshowed an increase of 23 pounds (2995 momme), but allthe dogs died. The total increase in weight of the otherthree dogs (which may be called the first B group) was only11 pounds (1430 momme), as compared with their originalweight, but all of them were alive and healthy at theconclusion of the experiment ; it is therefore not alwaysreasonable to take the increase of body weight as a positiveproof of health.The second experiment, in which six dogs were also used,

was commenced on Sept. lst, 1885, and completed on

Nov. 30th, 1886. The principal articles of food given to.the first three of these dogs were rice and sweet potatoes,while those given to the other three consisted of boiledbarley, beans (soja hispidia), and sweet potatoes. The firstof these dogs weighed 191 pounds (2500 momme) and hada daily allowance of 72 ounces of rice, 1$ounces of sweetpotatoes, ounce of dried bonito, ounce of soy, and$ounce of miso. It at first decreased in weight but after-wards increased ; between the sixth and twelfth month ofthe experiment it suffered from spasms ; it died at the endof 383 days ; the principal post-mortem appearances werecongestion and hemorrhage in the peritoneum. The seconddog weighed 142 pounds (1860 momme) and had a dailyallowance of 5 ounces of rice, 1$ounces of sweet potatoes, ounce of died bonito, of soy, and ounce of miso. Its

weight fluctuated a good deal but at the commencement ofthe ninth month of the experiment there was an increase ofnearly one-eighth of the original weight. From the com-mencement of the eleventh month the animal becameemaciated and extremely weak but there was no paralysis ; itdied at the end of 322 days ; at the necropsy haemorrhage inthe mesentery and mucous membrane of the small intestinewas found and there was fluid in both sides of thethorax. The third dog weighed 11 pounds (1500 momme)and had a daily allowance of 5 ounces of rice, 1$ouncesof sweet potatoes, ounce of dried bonito, ounceof soy, and 4 ounce of miso. An increase of 22 ounces(20 momme) in its weight was maintained up to the end ofthe experiment which lasted for 421 days ; during the wholeof this time it showed little change in any respect. The

original weight of the fourth dog is not stated ; it had a

daily allowance of 5 ounces of barley, 2 ounces of beans,3-7,- ounces of sweet potatoes, ! ounce of dried bonito,s ounce of soy, and 4 ounce of miso. At the beginning ofthe fourth month of the experiment it had lost over a

quarter of its original weight, but its movements were veryactive and there was afterwards an increase in weight ; theexperiment lasted for 456 days. The fifth dog weighed1114 pounds (1500 momme) and had a daily allowance of2 ounces of barley, 22 ounces of beans, 1$ounces of sweetpotatoes, g ounce of dried bonito, s ounce of soy, and4 ounce of miso. The experiment was continued for456 days, during the whole of which the animal showed noremarkable change in its weight and nothing unusual

happened. The sixth dog weighed 314 pounds (4080 momme)and had a daily allowance of 72 ounces of barley, 22 ouncesof beans, 2 ounces of sweet potatoes, ounce of driedbonito, ounce of soy, and ounce of miso.Of the first three dogs (which may be called the second

A group) two died and the one which survived did notincrease in weight more than 20 momme, whereas with theother three (which may be called the second B group) eachincreased in weight during the last month and at the end ofthe experiment the increase was from 120 to 150 momme.Baron Takaki then continued as follows ]The result of the two experiments mentioned above was

that those six dogs to which rice was given as the principalfood, in spite of an increase in weight all but one diedbefore the expiration of the experiment. The increase ofweight of six dogs to which barley, beef, and beans weregiven as their principal food was not so conspicuous as inthat of A group, but every one of them was healthy andvery active both mentally and bodily till the end of the

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experiment. Therefore, although these experiments seem tobe very crude yet the results certainly prove that the varietyof food consumed and its combination have direct influenceupon the health of animal life. It is not quite proper to con-clude that the causes which affect the health and developmentof man will produce in some ways the same results as in dogs,but I have no doubt that the health of man is also greatlyinfluenced by the variety and combination of food con-

sumed.By the beginning of 1890 the reformed diet was crowned

with a complete success, and not only was the beri-beri

wholly exterminated but also the general diseases becamegreatly decreased. In the same year the Imperial Ordinancefor the reformed diet was issued and thus my original objectwas fulfilled.

All through these years of hardships I tried to explain myviews to others by comparing the food to gunpowder. Isaid that the former is the primary force of the human bodyas is the powder in the case of the gun, so it is just asimportant to select the food suitable for sailors as the

powder for guns and rifles.In former time the food was supplied according to the

monetary system without any regard for quality or quantity.Therefore, when the price of food articles was high the mencould not get sufficient nutrition for the maintenance ofhealth, although they were able to get more when it waslow. As a consequence, the distribution of food was unequalat times and although the sailors could stand any hardshipat one time yet they could not at other times owing to thewant of food. Such a state of things is a serious danger forthe country in time of need. Tne gunpowder is suppliedin definite quantity and of the best quality without consider-ing the amount of expense. This is what I wished to havewith regard to the supply of food. By doing so we can

preserve an equal supply of suitable food at all times andalso keep the officers and men in good health so that theycan bear hardships both in peace and war. In 1890, as thesuccess of the reformed diet became positive, the particularsconcerning the preventive measures taken for beri-beri werecompiled into a book and presented to the Minister of theNavy.As the result of the reformed diet and the improvement of

the naval hygiene, during six years from 1884 to 1889 theamount of expense saved totalled 1,232,416 yen (about123,242). On Oct. 16h, 1890, I for the third time had thehonour of an audience with His Majesty the Emperor andpresented the following facts: 1. As I foretold on theoccasion of the presentation to His Majesty in 1885 beri-beri had now been completely exterminated from the

Imperial Navy. 2. The present condition of the health ofthe Imperial Navy and the economic influence of the im-proved diet. 3. The fear of the inability of the naval officersand men to endure hardships in time of need had now gone.4. The general tendency of beri-beri to increase amongstudents and others without any regard to occupation. 5.The appearance of beri-beri all over the country and itstendency to increase seemed to have its origin in the re-formed land-tax of the sixth year of Meiji (1873). Sincethat time the habit of eating rice as the chief food settledupon the remote districts ; and besides, owing to the generaltendency throughout the country to raise mulberry leaves,the production of rice and other cereals markedlydecreased. In consequence, the vegetable albuminatescontained in food necessary for bodily nutrition decreased,while, on the contrary, the amount of carbohydratescomparatively increased, thus causing the increase of thedisease.On thinking over my past experiences I cannot hesitate tu

declare that the present improved condition of the ImperialJapanese naval hygiene was due to having had an ableman at the head of the navy and also to the education ofmedical officers. Because if we had not such a man at thehead my suggestions would not have been taken up or if themedical officers were not thoroughly educated they could nothave succeeded in the task of the preventive measures. Th(success of the new diet system and the attaining of my longcherished desire were accomplished owing to the late CounlJungi Kawamura who was the Minister of the Navy when lwas made the Chief Director of the Medical Bureau. WherI first took up official duty as the Director of the MedicaBureau 1 told the Ccunt that if he would give me full powerto execute whatever I deemed necessary in order to keep ulthe health of the naval officers and men so as to make thenfit for any duty I would endeavour not to interfere with hi:

plans in regard to education, training, duties of officers andmen. These plans, it may be mentioned, seemed to be

throwing too much work on the men and medical officerswere inclined to object. He then answered, "All right."So that whenever I wanted to try any new plan he alwayssupported me in carrying it out as long as circumstancesallowed.

In order to maintain the health and efficiency of the menI firmly believe it to be of paramount importance to havethe following facts in constant observation. A carefulselection of men at the time of enlistment and the main-tenance of their health are absolutely essential for the objectof having an army and navy. To fulfil these objects theremust be an organisation in which the medical officers andnurses must be properly educated so as to fit them for theirduties and the officers and men of other branches must betaught elementary physiology and hygiene. Accordingly,in Japan elementary physiology and hygiene are taughtto cadets and officers, in addition to the subjectsspecial to themselves, both at the Naval College and theAcademy.

TABLE XII.-Casualties in Action with their Results in the

Japanese and Russian War ending on Dec. 5th, 1905.

Percentage of killed and died from wounds, 54; killed, 51 percent.; returned to duty, 90.8 per cent.; invalided, 6 per cent.; stillin hospital, 3 per cent.

"A." Casualties in the Engagentent outside of Port Arthur,Feb. 9th, 1901,.

"B." Casualties in the Engagement of the Fellow Sea onAugust 10th, 1904."

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" C." Casitalties in the Engagement at the South-Eastern Coastof Korea.

"D:’ Casualties among the Naval Men at the Siege of Port Arthur.

" E." Casitalties in the Battle of the Sea of Japan on May 27th, 1905.

" F." Cctsxccalties during the Period between Feb 9th, 1904, andAugecst 13th, 1905, excluding the Big Battles.

Remarks.-The percentage of "killed in the navy was,as is seen in the table above, 51 per cent , while that in thearmy was 28 per cent., thus showing that the " killed" rateis much larger in the navy. This is no doubt due to themore powerful weapons used in the navy which cause greatdamage from explosive shells. All the wounded cases have

been aseptically treated under strict observation and, ofcourse, when the necessity arose, cases were treated anti-septically according to the nature of each case. Surgicaloperations were generally avoided as much as possiblebecause it was found that the conservative surgery gavethe best result.In our army and navy before the battle commences we

are in the habit of wearing new clothes after cleaning thebody thoroughly as a matter of self-respect and this is alsouseful as a preventive method against the introduction ofany infection from the outside when a man is injured orwounded.

The Boulstonian LecturesAUTO-INTOXICATION: ITS RELATION TO

CERTAIN DISTURBANCES OF BLOODPRESSURE.

Delivered before the Royal College of Physicians of London onMarch 13th, 15th, and 20th, 1906,

BY H. BATTY SHAW, M.D. LOND.,F.R.C.P. LOND.,

LECTURER IN THERAPEUTICS, UNIVERSITY COLLEGE, LONDON ; ASSISTANTPHYSICIAN TO UNIVERSITY COLLEGE HOSPITAL AND TO THE

HOSPITAL FOR CONSUMPTION AND DISEASES OF THE

CHEST, BROMPTON.

LECTURE III.1

Delivered on March 20th.

MR. PRESIDENT AND GENTLEMEN,-In the last lecture

reference was made to the various disintegration productswhich are formed when proteids and nucleo-proteids breakdown. Attention was also called to the work done bySalkowski who has pointed out so admirably the import-ance of autolysis. Salkowski found that the autolysed livercontained not only substances which might be derived fromthe body proteid of the cell but also other substances whichindicated dissociation of the nucleo-proteid of the nucleus.In his control experiments nucleo-proteid was found, butthis was quite absent in the liver preparation exposedto autolysis in a thermostat. This was further confirmed

by the observation that the phosphoric acid which hadgone into solution was increased in amount, more so thancould be explained by the decomposition of jecorin andlecithin which are known constituents of the liver. Withsuch evidence before him Salkowski years ago insisted onthe existence of intracellular enzymes. The doctrine thatcellular activity is intimately associated with the mainten-ance of the natural appearance and condition of the cell hasled to error in the past and it is now quite freely acceptedthat the enzymes present in cells are capable of beingextracted and will exert their influence even when dislocatedfrom the cell body. To study the influence of such bodieswe must have knowledge of the substance on which they actas well as on the materials which they produce by such action.That these causes-namely, the intracellular ferments-arevery labile and refuse to yield the knowledge of their ulti-mate composition is a grdat reason for the difficultiesmet with in the study of such agents and of their

importance. The intracellular ferments in common withother ferments are destroyed by a temperature of 1000C.Precipitation of the solution containing them causes them tobe carried down in the precipitate. They are of a colloidalnature and it is therefore not strictly true that they aresoluble in water. Extraction with water or salt solutions oforgans which have been ground up with sand is a commonmethod of obtaining intracellular ferments. Buchner has,however, introduced hydraulic pressure as a substitute forextraction by this method and has obtained zymase fromyeast which had hitherto failed to yield this ferment byother methods of extraction. The majority of intracellular

1 Lectures I. and II. were published in THE LANCET of May 12th(p. 1295) and 19th (p. 1375), 1906, respectively.